Taking care of any child requires skill, patience, sensitivity and dedication. But some children are more difficult than others. If you’re looking after a kid with challenging behaviors, the task can be far more demanding. Learning a few skills — both for caregivers and children — can make a big difference, as a University of California, Davis program shows.
The weekly seven-session intervention called Parent-Child Care (PC-CARE) developed at the UC Davis CAARE Center in Sacramento, has been used in several clinical trials in an attempt to find the most effective ways to work with these children and their caregivers.
A recent study of the program is the first randomized controlled trial to look at its effectiveness. Often considered the “gold standard in research,” a randomized controlled trial means the participants testing the program are chosen at random from an eligible population and the control group (the participants not involved in the variable manipulated by the experiment — in this case, the program) is also chosen at random from the same eligible population. Such random selection ensures that the study is less likely to be affected by experimenters’ biases, whether conscious or unconscious.
Primary care pediatricians referred over 100 children described as exhibiting difficult behaviors.
In order to be considered for the study, participating children had to meet these criteria:
- Be between 2 and 10 years of age
- Have one participating caregiver who lives with the child at least 50 percent of the time
- Be a pediatric patient within the university health system
- Have family that can participate with services in English
- Exhibit challenging behaviors as reported by the caregiver
The hope was that kids and their caregivers who were chosen to take part in in the PC-CARE treatment program would gain valuable emotional and behavioral skills. As Brandi Hawk, a co-developer and supervisor of PC-CARE and the principal investigator of the study, said In a press release, “Many families struggle with managing challenging child behaviors but it is difficult to find behavioral health support. Because PC-CARE is brief and able to be conducted in many locations, it may allow providers to help more families in a shorter amount of time.”
Caregiver-child pairs participating in the program had weekly, 50-minute sessions that among other activities included therapists teaching caregivers and children a 10-minute lesson on positive communication, as well as calming and behavior-management skills. New skills were taught each week and built upon each other.
The therapists also conducted a four-minute observation of each child and caregiver playing together and rated how well the caregivers used five specific positive communication skills known as PRIDE, which stands for:
Ultimately, the PC-CARE program proved to be a win-win for caregivers and their kids with challenging behaviors.
- Praise: Offering a positive evaluation including both nonspecific compliments such as “Nice!” and specific praise such as, “Nice work playing with the toys!”
- Reflect: Repeating or rephrasing the child’s appropriate verbalization. So, for example, if the child says, “I’m building a house” the caregiver responds, “You’re building a house.”
- Imitate. Following the child’s lead, such as a parent saying “I’m driving my car just like you.”
- Describe. Describing the child’s behavior in a way that doesn’t evaluate it, such as, “You are drawing a rainbow.”
- Enjoy. Expressing positive feelings about a current situation such as, “I’m having fun playing with you.”
Ultimately, the PC-CARE program proved to be a win-win for caregivers and their kids with challenging behaviors. It gave kids some tools for calming down and taught parents skills they could use to make it easier to connect with their children. Not only did parents and caregivers report improved behaviors in their children and experience less stress, the study found that parents and caregivers demonstrated better communication skills and doubled their total number of PRIDE skills from pre- to post-treatment.
The study is published in Child Psychiatry & Human Development.